Examining Moral Injury in Medicine
Wendy Dean, MD, talks about her recent book “If I Betray These Words,” an honest look at keeping the Hippocratic Oath in a capitalistic health-care system.
https://www.webmd.com/a-to-z-guides/video/wendy-dean-moral-injury
— TRANSCRIPT —
JOHN WHYTE
Physician burnout is a topic that we’ve covered quite a bit on WebMD and Medscape. It doesn’t just impact the physician. It also impacts his or her family, the institution for which they work, as well as the entire health ecosystem. It’s a problem that started before the pandemic, but certainly has been exacerbated by it. So what do we need to do to fix it? How do we make it better? My guest today may have the solution.
Dr. Wendy Dean is the co-founder of Moral Injury of Healthcare. She has a new book out, If I betray These Words, where she interviews physicians who talk about how they feel trapped between the patient-first values of their Hippocratic oath and the business imperatives of a broken health system. Wendy, thanks for joining me.
WENDY DEAN
Thank you. It’s such a pleasure to be here.
JOHN WHYTE
I loved your new book. And what I want to ask you first is, we talk about burnout, but you talk about this concept of moral injury. And I have to say, that sounds pretty serious, moral and injury, right? So I want to ask you if you can tease out what you’re talking about.
WENDY DEAN
So moral injury is this sense that clinicians have they know what their patients need, and they cannot get it for them because of constraints outside of their control. And what that does is it causes us to wonder whether we can be the doctors that we thought we could be. So it’s this sense that we made a promise to society that we would heal and that we would put our patients before all else. And yet as soon as we go out into practice, we realize that there are so many barriers in the way between what we know we should do and what we’re able to do.
What we’re realizing is that as medicine has become more corporatized, our voices as physicians matter less and less. It’s starting to become more and more about what administrators need, what the business of health care needs. Now, when I say that, I don’t intend to mean that anyone has ill intent when they go into this. But it’s almost as though the structure has taken on a life of its own.
JOHN WHYTE
But are the values misaligned? So what you’re trying to do as a health professional may be different than what a health executive is doing and what actually then a patient wants. Is that the root cause of it?
WENDY DEAN
We are getting to a point where we’re not talking to each other anymore, which means that we’re not making sure that our values are all aligned. And the executives are trying to keep the healthcare system alive. Physicians are trying to keep patients alive in alignment with their values. And those sets of values don’t always overlap. So, yes.
JOHN WHYTE
And the moral injury is not just for physicians. We should be clear. You and I are physicians. We’re talking about it from the perspective of physicians. But correct me if I’m wrong, it’s also the same in terms of moral injury as it relates to nursing, as it relates to pharmacy, as it relates to the entire health ecosystem. Tell us how it’s impacting those health professionals.
WENDY DEAN
They have come to us and said the same thing that this is our language too. From social work to physical therapists to nurses, they are all feeling the same pressure. And in fact, there is newly emerging research that shows that administrators feel it too. 40% of administrators during the pandemic acknowledged some level of moral injury. So it is a system-wide challenge.
JOHN WHYTE
Your subtitle in the book is “Moral Injury in Medicine and Why it’s so Hard for Clinicians to Put Patients First.” But when we’re talking about moral injury, we’re talking about the clinicians too in what’s important to them and how they do their job, but also have balance with their lives. So how do you do both? You want to put the patient first, right? But you also have to be cognizant of your own abilities, your own time constraints, the importance of social interactions and family and being able, sometimes, to tune out. How do you do both?
WENDY DEAN
So I think the way to do both is to have systems that work better. Because we all want to put our patients first, and the reason that we can’t is we’re distracted by systems challenges. If we make our systems better, and we take away those barriers between what we know we want to do and actually accomplishing it, I think we could smooth that balance.
JOHN WHYTE
What’s it doing to the clinician? We’ve seen incidences increase in physician-assisted suicide, in substance abuse. Talk to us about what you’ve learned is the impact on clinicians.
https://www.webmd.com/a-to-z-guides/video/wendy-dean-moral-injury